Clinical profile of patients with menorrhagia and its correlation with endometrial histopathology and sonographic features

Menorrhagia is one of the most common gynecologic complaints in contemporary gynecology. It is defined as total blood loss exceeding 80 ml per cycle or menses lasting longer than 7 days. Current gynecological survey reports that 30% of all pre-menopausal women perceive their menses to be excessive. So, the main aim of this study was to correlate clinical profile of patients with menorrhagia, etiological factors of menorrhagia, endometrial patterns in cases of menorrhagia, sonography findings in these patients.

This is a prospective study of 100 patients with complaints of menorrhagia that were randomly selected from out-patient department of a tertiary care hospital. In all cases of menorrhagia, detailed history followed by examination and a particular set of investigations including USG was done. All women were subjected to D and C and histo-pathological report taken into account. However all cases of Puberty menorrhagia were excluded from this study as D and C could not be done in them. Treatment was given depending upon cause/age/parity/ family/completion/patient’s desire.

AUB is the most common cause of menorrhagia in this study group (60%) with leiomyomas as the second commonest cause (24%). Other causes found were adenomyosis (8%), polyp (4%), IUCD (4%). Maximum cases of menorrhagia are in 40-50 years age group.

To conclude AUB (60%) was the commonest cause of menorrhagia followed by leiomyomas (24%), adenomyosis (8%), IUCD (4%) and polyps (4%). Menorrhagia was most common in multiparous (78%) and peri-menopausal age group (40-49 years). Proliferative endometrium was most commonly observed histo-pathological pattern in 58% cases. Leiomyoma was the commonest sonological finding seen in 24% cases followed by adenomyosis in 8% cases. Metrics

Long CA, Gast MJ. Menorrhagia. Obstet Gynecol Clin North Am. 1990;17(2):343-7. Butler WJ. Telinde’s operative gynaecology. normal and abnormal bleeding. 9th ed. Wolters Kluwer. 2003:457. Berek JS. Abnormal bleeding In. Berek JS, Oliver DL (edl). Novak’s Gynecology-Self-Assessment and Review 12th end. Philadelphia. Pa: Lipincott Williams and Wilkins: 331-398. World Health Organization. Report of a WHO Scientific Group. Research on the menopause in the 1990s. WHO Technical Report Seriods 866. Geneva. WHO; 1996. Reinfold C. Atri M, Metlo A. Zakarian R. Aldis AE. Bret PM. Diffuse uterine adenomyosis; morphologic criteria and diagnostic accuracy of endovaginal sonograph. Radiolo. 1995;197:609-14. Long CA. Gast MJ, Menorrhagia NA. Menstrual cycle disorders. COG. 1990;17(2):348. Goodmin NJ, Valentic Hall JE. Effects of uemia and chromic hemolysins on the reproductive cycle. Am J Obstet Gynecol. 1968;100:52. Wilansky DL, Greisman B. Early hypothyroidism in patients with menorrhagia. Am J Obstet Gynecol. 1989;16(32):673-7. Novak ER, Jones GS, Jones HW. Novak’s Textbook of Gynaecology. 13th edn. Wolters Kluwer; 1971: 319. Field CS. Dysfunctional uterine bleeding. In Prim Care. 1988:15(3):561-72. Davey DA, DUB, Dewhurst’s Textbook of Obstetrics and Gynaecology. PG 3rd edn; 624-644. Taylor ES. Essentials of Gynecol. 4th ed. Wolters Kluwer; 1954:426-435. Jeffcoate. Abnormal and excessive uterine haemorrhage. Jeffcoates principles of Gynaecology. 5th edn; 1987:512-531. Marino J, Eskenazi B, Warner M. Uterine leiomyomas and menstrual cycle characteristics in a population basedl cohort study. Hum Reprod. 2004;l(19):2350-5. Stewart E, Uterine Stewart E. Uterine Fibroids. Lancet. 2001;357:293-8. Ligon A, Morton CC. Leiomyomata: Heretablity and Cytogenetic studies. Hum Reprod update. 2001;79:202-7. Lee NC, Dikker RE, Rubin GL. Confirmation of the preoperative diagnosis for hysterectomy. Am J Obstt and Gynecol. 1989;150:283-7. Fedele L, Bianchi S, Drota M, Brios Chi D, Zannotif Vercellini. Transvaginal USG versus hysteroscopy in diagnosis of uterine submucous myomas. Obstst and Gynecol. 1995;77:745-8. Tafazolf F, Reinhold C. Uterine adenomyosis: current concepts in imaging. Semin Ultrasound CT MR. 1999;20:267-77. Hatasks H. The evaluation of abnormal uterine bleeding. Clin Obstet Gynecol. 2005;48:258-73. McCausland VM. McCausland AM. The response of adenomyosis to endometrial ablation/ resection. Hum Reprod Update. 1998;4:350-9. Bostsis D, Kassanos D, Antoniou G, Pergiotis E, Karakitsos P. Adenomyoma and leiomyoma: differential diagnosis with transvaginal sonography. J Clin Ultrasound. 1998;26:21-5. Bromley B, Shipp TD, Beneaceraf B. Adenomyosis: sonographic findings and diagnostic accuracy. J Ultrasound Med. 2000;19:529. Hoeft CM, Syrop CH, Stovall DW, Voorhis BJ. Sonohysteroscopy in premenopausal women with and without abnormal bleeding. Obstet Gynecol. 1999;94:516-20. Purandare CN. Ultrasonography in menorrhagia. J Obstet Gynecol India. 1996:383. Pilli GS, Seth B, Annapurna D. Dysfunctional ulterine bleeding (Study of 100 cases). J Obstet Gynecol India. 2002;52(3):87-9. Role of transvaginal sonography in investigating the causes of menorrhagia. Lady reading hospital. Peshawar. J Postgradn Med Inst. 2006;20(1):40-3. Pilli GS, Bhavana Seth, Annapurna D. Dysfunctional ulterine bleeding (study of 100 cases). J Obstet Gynec India. 2002;52(3):87-9. Bhattacharji SK. DUB Correlation of endometrial pattern with clinical Behaviour. J Obstet Gynecol India. 1964:372-9. Shaheen S, Akhtar S, Utman N. Causes of menorrhagia and its pathological diagnosis by dilatation and curettage. Department and Gynaecology. Lady Reading hospital. Peshawar. J Postgrad Med Inst. 2005;19(1):62-6. Joshi SK, Deshpande DH. Clinicopathological study in 274 cases of DUB. J Obstet Gynecol India. 1964;XIV:360-70. Maheshwari V. Endometrial changes in abnormal bleeding. J Obstet Gynecol India. 1996.